The asthma of the esophagus

Tuesday

Dear Dr. Donohue: Will you please discuss eosinophilic esophagitis? I have it, and I have a hard time eating.

I have never been so sick in my life. I am 67 and was told it is unusual for an older woman to have it. I asked my doctor for information on it, and she said to look it up on a computer.

I am on Protonix and Flovent. I get feelings in my esophagus like asthma and heaviness in my chest. -- Anon.

Dear Anon.: You have an illness that is an infant among medical illnesses. It was first described in 1993. It's painful and difficult swallowing of solid food. The food might stick in the esophagus on its way down. You name your swallowing feelings aptly. It has been referred to as asthma of the esophagus.

Allergies might have a role in causing it. The immune system does participate. Eosinophils, part of the immune system, are one of the five kinds of white blood cells. Their numbers are few, but they increase in people with allergies. In this condition, the blood eosinophils infiltrate the esophagus.

Eosinophilic esophagitis can occur at any age and to either sex, but it happens most frequently to men between the ages of 20 and 40. Children who have it often have episodes of vomiting and stomach pain.

A biopsy of the esophagus shows the eosinophils when the biopsy is examined with a microscope. Scope inspection of the esophagus and X-rays taken after a person swallows barium demonstrate a peculiar ring pattern. The esophagus might narrow, and that adds to the swallowing problem.

You are on the medicines recommended for this condition. Protonix is one of the medicines used for heartburn -- gastroesophageal reflux disease. It stops production of stomach acid. It doesn't work as well for eosinophilic esophagitis, but it is given a trial. Flovent (fluticasone) is an asthma medicine. It might be only a matter of time before its effect kicks in.

Sometimes the doctor has to forcefully dilate a narrowed esophagus.

Dear Dr. Donohue: My husband died recently. At first, his diagnosis was aplastic anemia. Then it changed to myelodysplastic syndrome.

His brother died two years ago of polycythemia. I know both have to do with the bone marrow. What are the differences? -- E.W.

Dear E.W.: "Myelo" here refers to bone marrow, the place where blood cells are made. "Dysplasia" indicates abnormal development or growth. Myelodysplasia interferes with the normal production of blood cells.

Eight separate kinds of myelodysplasia exist, each with slightly different life expectancies and slightly different symptoms. Almost all of them feature anemia, a shortage of red blood cells. Anemia symptoms, therefore, are common to the myelodysplastic illnesses -- fatigue, weakness, breathlessness upon slight physical effort.

Many therapies have been tried to restore the marrow's normal red blood cell production. High-intensity treatment using hematopoietic stem cells and chemotherapy is possible in younger patients, but is too taxing in older patients, who often have other serious illnesses. Blood transfusions keep many people going for a period of time. Other treatments are available.

Dear Dr. Donohue: My 65-year-old daughter is in a live-in relationship with a man who is 71 and who has a diagnosis of prostate cancer. My concern is the possibility of him passing cancer cells to my daughter through sexual relations.

They consulted her general practitioner about the cancer question and were told they have nothing to worry about. Your response will be most greatly appreciated. -- B.N.

Dear B.N.: Prostate cancer is a male-only cancer. It is not transmitted from a man to a woman through intercourse or in any other way.